CHILD GENERAL PASSPORT APPLICATION
for Canadians under 16 years of age (in Canada or in the USA)
GENERAL INFORMATION AND INSTRUCTIONS
Aussi disponible en français
Failure to complete all the required sections of this form will result in your application being rejected.
Entitlement to a Canadian Passport
A Canadian passport is the only reliable and universally
accepted travel and identification document for Canadians
who travel abroad.
Canadian passports are issued to Canadian citizens only.
If applying for an individual passport for a child under 16 years
of age, use this application form (PPTC 155) to apply.
Who May Apply for a Passport on Behalf of a Child?
One of the parents;
The custodial parent in cases of separation or divorce; or
The legal guardian.
Requirements Checklist
BOTH pages of the application form completed and signed
within the last 12 months.
TWO (2) identical passport photos of the child (see "Photo
Specifications").
Application form and one of the photos certified by
your guarantor.
Proof of Canadian citizenship (no copies or certified copies).
Any valid Canadian passport or travel document issued to
the child.
All documents that refer to custody or mobility of, or access
to, the child.
The fee.
Additional documents or information may be requested in
support of this application.
Periods of Validity for Passports Issued to Children
For a child aged:
3 to 15 years, the maximum period of validity is 5 years.
under 3 years, the maximum period of validity is 3 years.
Note: Children who have been issued a passport in their
first 12 months may be issued a one-time replacement passport,
free of charge, valid for the balance of the three-year validity
period of the original passport. Full application requirements
must be met. To ensure the photo is a current and true likeness
of the child, it must be taken within one month of the date the
application is submitted.
Processing Times
For information on current processing times, visit our
website at www.passportcanada.gc.ca or contact us by phone
(see "Contact Us", page 2).
PPTC 155A (09-01) M02
Applying by Mail
Mailed-in applications are processed in Canada.
BY MAIL BY COURIER
Passport Canada Passport Canada
Foreign Affairs and 22 de Varennes Building
International Trade Canada 22 de Varennes Street
Gatineau QC K1A 0G3 Gatineau QC J8T 8R1
CANADA CANADA
DO NOT mail or bring your application to a Canadian
government office in the USA. However, passport applications
and related forms are available from these offices.
The original documents that you enclose with your
application are valuable. To ensure that these documents
are not lost or misplaced, it is preferable to use a courier
or mail service that allows you to trace your mail.
Applying in Person
For Canadians living in Canada:
At a Passport Canada service location
At a participating Canada Post office
At a participating Service Canada Centre
Our service locations are listed on page 2 of this application and
on our website at www.passportcanada.gc.ca.
For Canadians living in the USA:
If the child requires a passport in exceptional
circumstances, contact the nearest Canadian
government office. Canadian government offices in the
USA are listed on page 2 of this application and on our
website at www.passportcanada.gc.ca.
This form can only be used to submit an application by mail
(see "Applying by mail") or in person at a Passport Canada
service location (in Canada).
Fees
For a child aged – 3 to 15 years – CAN$37
– under 3 years – CAN$22
Note – These fees are subject to change.
– Only Canadian funds are accepted.
Important – Every person who requests a passport service
must pay the applicable fee. This fee is non-refundable.
Preferred method of payment
Debit (Interac) (In person only), or
(Complete section on
Credit card
application form.)
Other acceptable methods of payment
Certified cheque or money order/international money order
(postal or bank) payable in Canadian funds to the Receiver
General for Canada
Administrative fees and any applicable interest will be applied
to all dishonoured payments.
Page 1 of 4
 Contact Us
General information is available 24 hours a day, 365 days a year. Specific information is available during regular office hours.
INFORMATION ON PASSPORTS AND FEES INFORMATION ON TRAVEL CONDITIONS AND REQUIREMENTS
Website: www.passportcanada.gc.ca Website: www.voyage.gc.ca

Toll-free: 1-800-567-6868
Outside continental USA: 819-997-8338
TTY (For persons who are deaf or hard of hearing)
Toll-free: 1-866-255-7655 (7:30 a.m. to 8:00 p.m. ET)
To obtain the most recent version of this form, visit our website.
Application forms are also available in Braille, on diskette or in large print for persons with visual impairment.

Passport Canada Locations (NOT MAILING ADDRESSES)

DO NOT mail or use courier services to send your application form directly to a Passport Canada service location in Canada listed below.
However, passport applications and related forms are available from these service locations or may be obtained online at www.passportcanada.gc.ca.
CANADA
ALBERTA NEW BRUNSWICK North York Laval
Calgary Fredericton Suite 380, 3rd Floor Suite 500, 5th Floor
Suite 254 Suite 430 Joseph Shepard Building 3 Place Laval
Harry Hays Building Frederick Square 4900 Yonge Street Montréal
220-4th Avenue South East 77 Westmorland Street Ottawa West Tower, Suite 103
Calgary (South) (English only) NEWFOUNDLAND AND Level C, East Tower Complexe Guy-Favreau
14331 Macleod Trail SW LABRADOR C.D. Howe Building 200 René-Lévesque Boulevard West
Edmonton St. John's (English only) 240 Sparks Street Pointe-Claire
Suite 126 Suite 802 Scarborough (English only) Suite F-016A
Canada Place Building TD Place Suite 210 Fairview Pointe Claire Shopping Centre
9700 Jasper Avenue 140 Water Street 200 Town Centre Court 6815 Trans-Canada Highway
BRITISH COLUMBIA NOVA SCOTIA St. Catharines Québec
Richmond (English only) Halifax Suite 600 Suite 200, 2nd Floor
Suite 310 Suite 1508, 15th Floor Landmark Building Place de la Cité, Tour Cominar
5611 Cooney Road Maritime Centre 43 Church Street 2640 Laurier Boulevard
Surrey (English only) 1505 Barrington Street Thunder Bay Saguenay
Suite 900 ONTARIO 2nd Floor Suite 408
13401-108th Avenue Brampton (English only) 979 Alloy Drive Immeuble Saint-Michel
Vancouver Suite 401 Toronto (English only) 3885 Harvey Boulevard
Suite 241 40 Gillingham Drive Suite 300 Saint-Laurent
Sinclair Centre Hamilton 74 Victoria Street Suite 112
757 Hastings Street West Plaza Level Whitby 3300 Boulevard de la Côte-Vertu
Victoria Standard Life Building Whitby Mall SASKATCHEWAN
Bay Centre 120 King Street West 1615 Dundas Street East Regina
Level 4 Kitchener Windsor Suite 500
1150 Douglas Street Mezzanine Level Suite 503 1870 Albert Street
MANITOBA 40 Weber Street East CIBC Building Saskatoon
Winnipeg London 100 Ouellette Avenue Suite 405
Suite 400 Suite 201, 2nd Floor QUEBEC Federal Building
433 Main Street 400 York Street Gatineau (Hull) 101-22nd Street East
Mississauga (English only) Commercial Level 2
Suite 116, 2nd Floor Place du Centre
Central Parkway Mall 200 Promenade du Portage All service locations are
377 Burnhamthorpe Road East wheelchair accessible.
USA
DO NOT mail or bring your application form to a Canadian government office in the USA listed below. However, passport applications and
related forms are available from these offices or may be obtained online at www.passportcanada.gc.ca.
ATLANTA DALLAS MIAMI SAN JUAN
The Consulate General of Canada The Consulate General of Canada The Consulate General of Canada The Honorary Consulate of Canada
100 Colony Square Suite 1700 First Union Financial Center Hato Rey Center
Suite 1700 750 North St. Paul Street Suite 1600 Suite 802
1175 Peachtree Street NE Dallas TX 200 South Biscayne Boulevard 268 Ponce de Leon Avenue
Atlanta GA DENVER Miami FL San Juan PR
BOSTON The Consulate General of Canada MINNEAPOLIS SEATTLE
The Consulate General of Canada Suite 2600 The Consulate General of Canada The Consulate General of Canada
Three Copley Place 1625 Broadway 9th Floor Suite 600
Suite 400 Denver CO 701 Fourth Avenue South 1501 Fourth Avenue
Boston MA DETROIT Minneapolis MN Seattle WA
BUFFALO The Consulate General of Canada NEW YORK WASHINGTON D.C.
The Consulate General of Canada 600 Renaissance Center The Consulate General of Canada The Embassy of Canada
HSBC Center Suite 1100 1251 Avenue of the Americas 501 Pennsylvania Avenue NW
Suite 3000 Detroit MI New York NY Washington DC
Buffalo NY LOS ANGELES SAN FRANCISCO
CHICAGO The Consulate General of Canada The Consulate General of Canada
The Consulate General of Canada 9th Floor 14th Floor
Two Prudential Plaza 550 South Hope Street 580 California Street
Suite 2400 Los Angeles CA San Francisco CA
180 North Stetson Avenue
Chicago IL
PPTC 155A (09-01) M02 Page 2 of 4
 INSTRUCTIONS
1 Child's Personal Information
NAME TO APPEAR IN PASSPORT
Write the child's name as you want it to appear in the passport. If this name is different from the name on the child's documentary
evidence of citizenship, the child's legal change of name document (original document from issuing authority) may be required.
Additional documents may be requested to verify the child's identity.
SURNAME (LAST NAME) AT BIRTH/FORMER SURNAME (FORMER LAST NAME)
Complete only if different from the surname (last name) to appear in the passport (for Passport Canada information only; will not
appear in the passport).
PLACE OF BIRTH
The place of birth must be provided on the application form. If you do not wish the place of birth to appear in the passport, submit a
written request. Be sure to contact the consulate or embassy of every country you plan to visit to ensure that the child will be
admitted if the passport does not include the place of birth.
SIGNATURE
Children 11 years of age or over MUST sign their usual
signature. The child's signature in section 1 will appear
in the passport. Therefore, the signature MUST NOT
exceed the inner limits of the signature box.

2 Information on Applicant
Both parents are requested to participate in obtaining passport services for their child and to sign the application form. The other
parent may be contacted. To avoid possible delays, we strongly recommend that you provide a long-form birth certificate showing
information on both parents. Where a legal guardian is the applicant, the other legal guardian as the case may be is also requested
to participate.
CUSTODY, SEPARATION AND DIVORCE
Where a court order or agreement exists referring to custody of the child, only the person with custodial rights may apply. All documents
that refer to custody or mobility of, or access to, the child must be provided. If a divorce has been granted, a copy of the divorce
judgement or order must also be provided. Where joint custody provisions exist, either parent may apply.
RELATIONSHIP WITH OTHER PARENT
Indicate your current relationship with the other parent: single, common law, married, separated, divorced, widowed. Indicate date
of marriage to the other parent, if applicable. Additional information or documentation may be requested.
For further information, contact Passport Canada.

3 Previous Canadian Passport

Enclose any valid Canadian passport or travel document issued to the child. If the child's current passport expires more than
12 months from the date of submission of the application, provide a written explanation for why you are applying at this time.
Should Passport Canada not be satisfied that you have a valid reason for applying early, your application for a new passport
may be refused.
If the valid passport has been lost, stolen, damaged, destroyed or is inaccessible, complete a "Statutory Declaration" form
PPTC 203, available from any Passport Canada service location in Canada, any Canadian government office in the USA or
at www.passportcanada.gc.ca. A Canadian passport, once reported lost or stolen, is no longer valid and is not to be used for
any travel.

4 Proof of Canadian Citizenship

Provide ONE (1) of the documents listed in section 4 of the application form (copies or certified copies are not accepted). It will be
returned to you. Additional information may be requested to confirm the child's citizenship.
CERTIFICATE OF BIRTH IN CANADA
A birth certificate may be obtained from the Vital Statistics authorities of the child's province or territory of birth. To avoid possible
delays, we strongly recommend that you provide a long-form birth certificate showing information on both parents.
If the child was born in Quebec
Only birth certificates issued on or after January 1, 1994, by the Directeur de l'état civil in the province of Quebec are accepted.
CERTIFICATE OF CANADIAN CITIZENSHIP
Large commemorative documents of citizenship issued after February 14, 1977, are not accepted. If the child requires a certificate
of Canadian citizenship, contact:
In Canada, the office of the Registrar of Canadian Citizenship: In the USA:
– Toll-free 1-888-242-2100 – The nearest Canadian government office.
– TTY (for persons who are – Citizenship and Immigration Canada www.cic.gc.ca
deaf or hard of hearing) 1-888-576-8502 (from 7:00 a.m. to 5:00 p.m. ET)
– Website www.cic.gc.ca
PPTC 155A (09-01) M02 Page 3 of 4
 5 Declaration of Guarantor
A guarantor is a person other than the applicant who confirms the applicant's identity and has knowledge of the child.
Your guarantor:
must be a Canadian citizen 18 years of age or older;
must hold a five-year Canadian passport that is valid or has been expired for no more than one year on the day you submit your
application;
must have been 16 years of age or older when he or she applied for the passport identified in section 2 of this application form;
must have known you (the applicant) personally for at least TWO (2) years*;
* To know an applicant personally means that the guarantor is able to confirm aspects of the applicant's personal
attributes such as name, approximate age, place of birth, physical description and some personal history such as
occupation and place of residence.
must provide the requested information contained in his or her passport;
must be accessible to Passport Canada for verification;
must reside in Canada, in the USA or in any of the areas where submission of this application form is authorized, e.g. Bermuda.
It is not necessary that the guarantor reside in the same country as the applicant.
A family member or person residing at the same address as you (the applicant) may be your guarantor, provided that he or she
meets the specified requirements. If you are the parent or legal guardian applying for a passport for the child, you cannot sign as
guarantor. However, if applicable, the other parent or legal guardian of the child may sign.
Your guarantor must perform free of charge the following TWO (2) tasks:
1. Complete and sign the "Declaration of Guarantor" section. (Ensure you have completed and signed the form before submitting
it to your guarantor.)
2. Write "I certify this to be a true likeness of (child's name)" on the back of ONE (1) of the child's photos, and sign.
Passport Canada reserves the right to request an alternate guarantor.
If you have not known an eligible guarantor for at least TWO (2) years, complete a "Statutory Declaration in Lieu of Guarantor"
form PPTC 132, available from any Passport Canada service location in Canada or any Canadian government office in the USA.
This form must be completed at your expense before a person authorized by law to administer an oath or solemn affirmation.
This may delay the processing time of the passport.

Photo Specifications
Your passport application will be rejected if the photo of the child SIZE AND PAPER
do not meet the following specifications: The photos must measure 50 mm x 70 mm in size
IMAGE INFORMATION (2 in. wide x 2 3/4 in. high).
Only the head and shoulders of young children must appear on Heavy weight paper is unacceptable.
the photo (e.g. no hands holding the child). Photos must be printed on plain, high quality photographic paper.
Photos must be taken with uniform lighting and not show PHOTOGRAPHER AND GUARANTOR
shadows or flash reflection on the face and head. Photos with Photos must be taken by a commercial photographer.
shadows on the face or background are unacceptable.
The name of the photographer or studio, the address and the date
Photos must show a full front view of the face with both edges the photo was taken (not the date the photo was printed) must be
of the face showing clearly. The face and shoulders must be provided directly on the back of one photo (see illustration).
centred in the photo and squared to the camera.
The guarantor must clearly write on the back of ONE (1) photo:
Eyes must be open and clearly visible. Glasses, including tinted "I certify this to be a true likeness of (child's name)".
ones with prescription, may be worn as long as the eyes are
clearly visible. Sunglasses are unacceptable.
Facial expression must be neutral (not frowning or smiling)
with the mouth closed.
The image must be clear, sharp and in focus.
Photos must be taken against a plain, uniform, white or
light-coloured background.
Photos must reflect/represent natural skin tones.
The length from chin to crown of head (natural top of head)
must be between 31 mm and 36 mm (1 1/4 in. and 1 7/16 in.).
Hats or head coverings are not permitted except when worn for
religious reasons and only if the full facial features are clearly visible.
Black and white or colour photos are acceptable.
Photos must be originals, not taken from any existing photo, and
have been taken within the last 12 months or if applying for
a one-time replacement passport, taken within the last month.
QUANTITY AND FORMAT
TWO (2) identical unaltered photos produced from the same film or
from the same electronic file capturing the digital image.
PPTC 155A (09-01) M02 Page 4 of 4
 IMPORTANT INFORMATION CONCERNING CHILDREN TRAVELLING ABROAD
Travelling with Children or Children Travelling Alone
Immigration authorities in most countries are becoming increasingly vigilant when children are crossing international borders.
Whether travelling alone or accompanied by an adult, each child travelling abroad must have a valid passport and may also
require supporting documentation. Prior to any travel that includes a child, you should contact the embassy or consulate of all
countries the child will be visiting to inquire about entry requirements.

Documentation to Facilitate Travel Abroad

The following documents may be required to support the entry of a child to another country:
Birth certificate showing the names of both parents
Documents pertaining to custody
If the child is travelling with one parent, a letter signed and dated from the other parent authorizing travel (letter may have to
be notarized)
If the child is travelling with someone other than the parent, a letter signed and dated from both parents authorizing travel
with that person (letter may have to be notarized)
If the child is travelling alone, a letter signed and dated from both parents authorizing travel (letter may have to be notarized)
If one of the parents is deceased, the death certificate.

Documentation and Tips to Facilitate the Return to Canada

The following tips may help to avoid delays when a child is returning to Canada:
Always carry proper identification for yourself and the child – passport, birth certificate, citizenship card, Record of Landing
(IMM 1000), permanent resident card or Indian Status Card.
If you have custody of the child, carry copies of documents specifying custody rights with you .
If you are not the legal guardian of the child, carry a letter of permission or authorization for you to have custody when
entering Canada. When a parent is travelling alone with a child, a letter from the other parent can also facilitate the return of
both the parent and the child. The letter should also contain telephone numbers where the parent or legal guardian can be
contacted.
If you are travelling as part of a caravan, ensure you are in the same vehicle as the child you are accompanying
when arriving at a border crossing.
Have the child memorize your home and/or office telephone number and teach him or her to call you in an emergency.

Custody Information
1. Custody arrangements in Canada may not be recognized in another country. In extreme cases, the child may not be able to leave
the country visited. It is recommended that, before leaving on a trip, you check with the embassy or consulate of the country or
countries the child will be visiting to determine what documentation may be required relating to the custody of the child.
For further information, contact:
Foreign Affairs and International Trade Canada:
In Canada 1-800-387-3124
Outside Canada 613-943-1055
2. If a custody dispute could possibly arise while travelling with the child, you should talk to a Canadian lawyer prior to your
departure. We suggest you also read the publication, International Child Abductions: A Manual for Parents.
For a free copy, call: You may also order a copy online or access an online version:
In Canada 1-800-267-8376 Website www.international.gc.ca
Outside Canada 613-944-4000

Protection of Information
Personal information provided on this application form is protected and used in accordance with the provisions of the Privacy
Act (Personal Information Bank No. FAI PPU 030). This information is collected under the Canadian Passport Order to
determine the current and ongoing entitlement of the child to a Canadian passport, to administer passport services and to
provide information to the Consular Affairs Bureau of Foreign Affairs and International Trade Canada in the event that the child requires
assistance while travelling abroad. The information provided, including the child's photo, is subject to routine verifications and security
queries. To further strengthen Canadian passport security, the photo is stored on an alphanumeric template and incorporated into the
passport as a digital image.
Passport Canada may use the services of third parties to receive passport applications submitted in person and to process the return
of incomplete passport applications. In the performance of these services, personal information will be protected and used in accordance
with the provisions of the Privacy Act.
Passport Canada may contact the applicant to solicit feedback about passport services.
PPTC 155 (09-01) M02
 Validate and Print Reset
INFORMATION

CHILD GENERAL PASSPORT APPLICATION PROTECTED

for Canadians under 16 years of age (in Canada or in the USA)

WARNING to all applicants and guarantors – Any false or misleading statement on this form or relating to any document in support
of this application including concealment of any material fact, may lead to refusal or revocation of a passport and be grounds for
criminal prosecution.
Failure to complete all the required sections of this form will result in your application being rejected.
1 Child's Personal Information
Surname (last name)
ELIAS
Given name(s) (see instruction no. 1)
CARTER JASON Date of Travel
Month Day
Surname (last name) at birth/former surname (former last name) (see instruction no. 1)
✖ Unknown
Date of birth Place of birth
Year Month Day CANADA
EDMONTON AB
2001 12 13 City Country Prov./Ter./State (if applicable)
Sex Eye colour Hair colour Height Weight
Female ✖ Male BLUE BROWN 4.0 FT/IN 56 LBS
Address of permanent residence
52152 VOYAGEUR EASTATES 62 SHERWOODPARK AB T8G 1A5
Number Street Apartment P.O. Box City Prov./Ter./State Postal/Zip code

Mailing address (If different from above)

Number Street Apartment P.O. Box City Prov./Ter./State Postal/Zip code

Children 11 years of age or over must sign in the signature block.

Date Signed at
Year Month Day
City Province/Territory/State

2 Information on Applicant
Is the child the subject of an adoption process? ✖ No Yes If yes, include all
Are there any separation agreements, court orders or legal proceedings documents
✖ No Yes
(see instruction no. 2)
pertaining to custody or mobility of, or access to the child?
Applicant (parent or legal guardian) Other parent or legal guardian
Surname (last name) at birth Surname (last name) at birth
BRISEBOIS ELIAS
Given name(s) Given name(s)
CHERIE CLAUDETTE JASON WILLIAM
Date of birth Country Date of birth Country
Year Month Day Year Month Day
CANADA CANADA
1976 11 23 1975 07 19
Relationship with other parent Date of marriage (if applicable) Relationship with parent applying Date of marriage (if applicable)
Year Month Day Year Month Day
MARRIED 1996 11 30 MARRIED 1996 11 30
Address (Number, Street, Apartment, City, Province/Territory/State, Postal/Zip code) Address (Number, Street, Apartment, City, Province/Territory/State, Postal/Zip code)
52152 VOYAGEUR EASTATES, #62, SHERWOODPARK, AB, 52152 VOYAGEUR EASTATES, #62, SHERWOODPARK, AB,
CANADA, T8G1A5 CANADA, T8G1A5
Daytime phone Evening phone Cell. number (optional) Daytime phone Evening phone Cell. number (optional)
780-922-5645 780-922-5645 780-922-5645
DECLARATION – I solemnly declare that the child named above is a Canadian citizen, DECLARATION – I solemnly declare that the child named above is a Canadian citizen,
that I am the parent or legal guardian of the child named above and that the statements that I am the parent or legal guardian of the child named above and that the statements
made in this application are true. I declare that I have read and understood the made in this application are true. I declare that I have read and understood the
WARNING to all applicants and guarantors above. WARNING to all applicants and guarantors above.

Signature of applicant (also sign section 4) Date Signed at Signature of other parent or legal guardian Date Signed at
Aussi disponible en français PPTC 155 (09-01) M02 Page 1 of 2
 Validate and Print

3 Previous Canadian Passport

Enclose any valid Canadian passport or travel document issued to the child. If the passport has been lost, stolen, damaged,
destroyed or is inaccessible, you must include with this application form a completed "Statutory Declaration" form PPTC 203,
available from any Passport Canada service location in Canada, any Canadian government office in the USA or at
www.passportcanada.gc.ca.

4 Proof of Canadian Citizenship

A To be completed if the child was born in Canada. Provide ONE (1) of the two documents listed below (no copies):
Registration number Date of issue
✖ Birth certificate in Canada 2001-08-035984 2003-03-28
Certificate number Date of issue
Certificate of Canadian citizenship

B To be completed if the child was born outside of Canada. Provide the following document (no copies):
Certificate number Date of issue
Certificate of Canadian citizenship

Declaration of Applicant
Surname (last name) of applicant (see General Information and Instructions, Given name(s) of applicant
page 1 "Who May Apply for a Passport on Behalf of a Child?")
ELIAS CHERIE CLAUDETTE
Relationship to child Surname (last name) of child Given name(s) of child
MOTHER ELIAS CARTER JASON
DECLARATION – I solemnly declare that the child named herein is a
Canadian citizen, that the photos enclosed are a true likeness of the child and
that the statements made in this application are true. I declare that I have read
and understood the WARNING to all applicants and guarantors on page 1.
Date Signed at
Year Month Day
City Province/Territory/State

5 Declaration of Guarantor (to be completed by the guarantor only if the applicant has completed and signed this application form)
Surname (last name) Given name(s)

Date of birth Canadian passport number Date of issue Date of expiry

Year Month Day Year Month Day Year Month Day

Surname (last name) in passport, if different Daytime telephone number Evening telephone number
( ) ( )
Address of permanent residence

Number Street Apartment City Province/Territory/State Postal/Zip code

DECLARATION – I solemnly declare that I have known I have known
the applicant identified above personally for at least the applicant for
TWO (2) years. I have certified on the back of ONE (1)
photo that the image is a true likeness of the child. I
declare that I have read and understood the WARNING
to all applicants and guarantors on page 1. Number of years Signature of guarantor
Name of applicant Name of child Date Signed at
Year Month Day
City Province/Territory/State

6 Credit Card Information

COMPLETE ONLY if you are not appearing in person and you wish to pay by credit card. FOR OFFICIAL
Name appearing on card USE ONLY
Authorization number
Card number Date of expiry
Month Year

AUTHORIZATION – I authorize Signature of cardholder Date

Year Month Day
Passport Canada to charge
C$ to my credit card.
PPTC 155 (09-01) M02 Page 2 of 2